Guest Columns

Don't mess with my Uber rating!

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Steven Littlehale
Steven Littlehale

My most recent trip to Washington, D.C., was wrapping up like most others. I was heading to Reagan Airport by way of Uber, but what happened next was not typical — and drove me to write this piece.

My Uber driver, Sammy, casually drove his Toyota Corolla up the off ramp, heading the wrong way onto the highway! In that moment, I found myself saying in an eerily calm voice, “Excuse me, please stop. This is the wrong way. Please back up.”

Please back up? I was headed toward possible death or disfigurement, so why at that moment did I choose an almost chirpy voice to express my potentially lifesaving request?

Oh, I do know why: to protect my Uber rating!

I hate to admit this to myself, let alone to you, but at that moment I was just as concerned about my driver giving me a poor rating as I was about facing probable physical harm, or maybe even worse … missing my flight.

Did you know Uber drivers rate their passengers? I didn't until my brother, sister and I got into a spirited conversation about who had the highest Uber rating. (I won, and if you knew my sometimes-ornery sibs, you would have guessed it too.)

Per Uber, “The rating system works to make sure that the most respectful riders and drivers are using Uber.” Its drivers may elect NOT to pick you up based on your low rating; apparently, the idea of not being picked up in a rainstorm due to a low rating overshadowed the consequence of a possible car accident.   

My thoughts turn to Nursing Home Compare and, more specifically, the Five-Star Quality Rating System, which was designed to “help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.”

It's undeniable that since Five-Star's inception, we've seen improvement across all domains. Just like the CMS Quality Measures, when tracked longitudinally, you cannot help but be impressed by the improvement our industry has made.

“Track it and we will improve” might be our industry's new tagline. But a more accurate statement might be “Consistently track it and be transparent … and we will improve.”

LifeBridge Health is a regional healthcare organization based in northwest Baltimore and its surrounding counties. PointRight was engaged to support the development of its SNF Collaborative, which focused on quality and patient experience while reducing the cost of care.

The collaborative's outcomes data were clear: Once common metrics were identified and made transparent to all stakeholders, rapid improvement was realized. LIfeBridge:

•  Reduced overall adjusted rehospitalization rate by 1.5 percentage points

•  Prevented rehospitalization of 193 residents and

•  Improved overall Five-Star by 7%

Similar findings are seen in our other acute/post-acute care collaboratives. The “secret sauce” is the use of standardized metrics that can be operationalized and made transparent to all stakeholders, not to mention a lot of hard work!

The “hard work” part of the equation cannot be minimized. Almost all SNFs in these collaboratives were committed to reducing rehospitalization rates and improving quality and this was evidenced in several ways.

We've all heard of the “Hawthorne effect” or “observer effect,” but I find that an inappropriate conclusion to this blog.

Shining a light might make the cockroaches vanish, but it's not going to magically resolve an issue as complex as rehospitalization or lower antipsychotic drug use – much like AHCA did through their well thought out Quality Initiative.

Back to Sammy. I did report him to Uber, and I suspect he rated me poorly as well. He blamed his error on the poor signage, which I replied (again, very nicely) that I had no problem seeing from the back seat.

I still maintain an Uber rating of 4.75. What's yours?

Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.


Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.